In which clinical condition is the use of an intrauterine contraceptive device (IUD) strictly contraindicated… - RML PRE 2025

RML PRE 2025

Obstetrics & Gynaecology

Easy

Appeared in: RML PRE 2025

Explanation

Active or recent (within the last 3 months) Pelvic Inflammatory Disease (PID) is an absolute contraindication for IUD insertion.
The insertion procedure can introduce or spread bacteria from the lower genital tract (cervix and vagina) into the upper genital tract (uterus and fallopian tubes).
This can significantly worsen an existing infection, leading to severe complications such as tubo-ovarian abscess, chronic pelvic pain, ectopic pregnancy, and infertility.
The risk is highest in the first few months after insertion.

Option A: This is an outdated contraindication. Modern guidelines from organizations like the American College of Obstetricians and Gynecologists (ACOG) state that IUDs are safe and effective for nulliparous women (women who have never given birth), including adolescents.
Option C: IUDs can be safely inserted immediately after a caesarean section (post-placental insertion) or at a postpartum follow-up visit (typically 6 weeks later). This is not a contraindication.
Option D: Age alone is not a contraindication for IUD use. Both hormonal and copper IUDs are considered safe and highly effective contraceptive methods for healthy women over the age of 35.

Clinical Relevance

Nursing practice connection: Knowing Contraindications for Intrauterine Device (IUD) Insertion helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a critical role in patient safety by conducting thorough screenings for contraindications before IUD insertion. This includes taking a detailed medical and sexual history.
Patient education is a key nursing responsibility. The nurse must counsel the patient on the signs and symptoms of PID (e.g., pelvic pain, fever, abnormal vaginal discharge) and instruct them to seek immediate medical attention if they occur, especially within the first month after insertion.
What if? If a patient has a remote history of PID (more than 3 months ago, fully treated, with no recurrence) but no current infection, an IUD is no longer absolutely contraindicated. However, it is a relative contraindication, and the decision should be made after careful counseling about the risks and benefits.

How to Approach the Question

First, identify the key phrase in the question: 'strictly contraindicated'. This means you are looking for an absolute reason why an IUD should not be used.
Next, evaluate each option based on your knowledge of contraceptive guidelines.
Consider Option A (Nulliparous women): Recall that modern guidelines have changed and now support IUD use in this population. This is not a strict contraindication.
Consider Option B (Pelvic inflammatory disease): Recognize that introducing any instrument through the cervix into the uterus during an active infection poses a high risk of spreading that infection. This is a major safety concern.
Consider Option C (After caesarean section): Remember that postpartum contraception is important, and IUDs can be placed immediately after delivery, including C-sections.
Consider Option D (Women > 35 years): Age itself is not a contraindication for IUDs. They are often recommended for this age group.

Concept Tested & Keywords

Concept Tested: Contraindications for Intrauterine Device (IUD) Insertion
Stem keywords: intrauterine contraceptive device (IUD), strictly contraindicated, risk of complications
Lead-in keywords: strictly contraindicated
Negative lead-in flag: false

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E6 Gynecology Williams p. 118-146

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart C (pp 404-604 of 604) pp. 192-194, 191-193